Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 000007 | OH |
N | 225XM0800X | Mental Health | 000007 | OH |
NPI | 1447563614 |
---|---|
Provider Name | Randy Grigsby |
First Address | Cincinnati, OH 45230 |
Second Address | Ashtabula, OH 44004-3107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |